Gramegna Andrea, Barone Ivan, Alicandro Gianfranco, Sotgiu Giovanni, Bellofiore Angela, Colombo Crizia, Arcadu Antonella, Ori Margherita, Blasi Federico, Simonetta Edoardo, Vicenzi Marco, Aliberti Stefano, Blasi Francesco
Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
ERJ Open Res. 2024 Sep 30;10(5). doi: 10.1183/23120541.01032-2023. eCollection 2024 Sep.
Bronchiectasis is a chronic respiratory condition characterised by airway and systemic inflammation with prevalence increasing with age. Given the median age of the patients, it is common to observe the presence of comorbidities, particularly cardiovascular diseases, which have been linked to adverse clinical outcomes. To investigate the pooled estimates of the association between bronchiectasis and coronary heart disease or stroke within this population, we conducted a systematic review and meta-analysis of the available scientific evidence.
Three investigators independently performed the search on PubMed and other sources and included studies published up to October 2023 according to predefined criteria. Relative measures of association between bronchiectasis and cardiovascular events were pooled and meta-analysed using a fixed-effects model. Studies were evaluated using the Newcastle-Ottawa Scale for assessing the quality of non-randomised studies in meta-analyses.
A final pool of nine studies was included in the systematic review, with a total of 22 239 patients. Meta-analysis of three high-quality cohort studies showed a pooled hazard ratio of 1.42 (95% CI 1.30-1.57) for coronary heart disease and 1.71 (95% CI 1.55-1.89) for cerebrovascular stroke.
The increased cardiovascular risk among people with bronchiectasis underscores the critical need to raise awareness of this association and to develop preventive strategies accordingly. Further translational studies are imperative to gain a deeper understanding of the complex interplay between inflammation, the immune system and endothelial dysfunction in this patient group.
支气管扩张是一种慢性呼吸系统疾病，其特征为气道和全身炎症，患病率随年龄增长而增加。鉴于患者的中位年龄，合并症尤其是心血管疾病的存在较为常见，这些疾病与不良临床结局相关。为了研究该人群中支气管扩张与冠心病或中风之间关联的汇总估计值，我们对现有科学证据进行了系统评价和荟萃分析。
三名研究人员独立在PubMed和其他来源进行检索，并根据预定义标准纳入截至2023年10月发表的研究。汇总支气管扩张与心血管事件之间关联的相对测量值，并使用固定效应模型进行荟萃分析。使用纽卡斯尔-渥太华量表评估荟萃分析中非随机研究的质量，对研究进行评价。
系统评价最终纳入了9项研究，共22239例患者。对3项高质量队列研究的荟萃分析显示，冠心病的汇总风险比为1.42（95%CI 1.30-1.57），脑血管中风的汇总风险比为1.71（95%CI 1.55-1.89）。
支气管扩张患者心血管风险增加凸显了提高对这种关联的认识并相应制定预防策略的迫切需求。进一步的转化研究对于更深入了解该患者群体中炎症、免疫系统和内皮功能障碍之间的复杂相互作用至关重要。
